2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack: A Guideline From the American Heart Association/American Stroke Association

Abstract

Kleindorfer et al2021 Guideline for the Secondary Prevention of Ischemic Stroke AdherenceA key component of secondary stroke prevention is assessing and addressing barriers to adherence to medications and a healthy lifestyle. If a patient has a recurrent stroke while on secondary stroke prevention medications, it is vital to assess whether they were taking the medications that they were prescribed and, if possible, to explore and address factors that contributed to nonadherence before assuming that the medications were ineffective. Antithrombotic DosingUnless stated otherwise in the recommendations herein, the international normalized ratio (INR) goal for warfarin is 2.0 to 3.0 and the dose of aspirin is 81 to 325 mg. Application Across PopulationsUnless otherwise indicated, the recommendations in this guideline apply across race/ethnicity, sex, and age groups. Special considerations to address health equity are delineated in section 6.3, Health Equity. DIAGNOSTIC EVALUATION FOR SECONDARY STROKE PREVENTION Recommendations for Diagnostic EvaluationReferenced studies that support recommendations are summarized in online Data Supplements 1 and 2. CORLOE Recommendations 1 B-R Recommendations for Diagnostic Evaluation (Continued) COR LOE Recommendations

Delayed Comprehensive Stroke Unit Care Attributable to the Evolution of Infection Protection Measures across Two Consecutive Waves of the COVID-19 Pandemic

“…We detailed pre- and in-hospital process times of hyperacute stroke care comprising onset-to-door, door-to-imaging, door-to-needle, door-to-groin, and onset-to-groin times. According to international stroke guidelines, secondary prevention medication, including antiplatelet and anticoagulant, use for ischemic stroke was evaluated for appropriateness [ 9 ]. We further analyzed length of hospitalization, and discharge disposition, including necessity of institutional care, as well as clinical and functional outcomes at discharge, using the NIHSS and mRS scores.…”

The Common Carotid Artery Thrombus and Embolic Stroke in the Setting of COVID-19 Infection

“…The patient was started on therapeutic doses of anticoagulation with apixaban 5mg twice a day for secondary stroke prevention 3 and atorvastatin 20 mg daily for mild dyslipidemia with goal of low-density lipoprotein <70. 12 He received physical and occupational therapy and improved significantly with only mild left arm pronator drift and paresthesia in his left face and arm at hospital discharge.…”

Engagement in Everyday Activities for Prevention of Stroke: Feasibility of an mHealth-Supported Program for People with TIA

“…Physicians in primary healthcare face challenges in terms of time constraints to offer non-pharmacological and non-surgical interventions to educate and support patients in their lifestyle changes [23], which suggests a need for interprofessional collaboration with other professionals such as nurses, occupational therapists, nutritionists, psychologists, and physical therapists in lifestyle-based preventive primary healthcare interventions. Although the benefits of a healthy lifestyle are clear [3,4,24], the consistency of implementation and long-term effects of primary healthcare-based lifestyle interventions is not well established [25,26].…”

“…App-based interventions combined with other strategies such as health education or peer support have been more effective in changing diet or physical activity behaviors as compared to stand-alone app-based interventions [28]. There is an urgent need to develop and test interventions that utilize a combination of strategies to support adherence to healthy lifestyle (behavior) changes (i.e., increased participation in health-promoting EEAs) among people that have suffered a TIA to prevent stroke and TIA recurrence [4]. Increasing literacy about risk factors and promoting individualized programs such as MMD based on personally meaningful priorities could be a way forward to successfully and sustainably incorporating healthy lifestyle patterns into everyday life [29].…”

“…MMD combines group sessions and individualized self-monitoring via a mobile phone application (app) to support persons at risk for stroke in incorporating engaging everyday activities (EEAs) into their lifestyle [1]. Major public organizations and government agencies such as the American Heart Association (AHA) and the Swedish National Board of Health and Welfare emphasize the need for preventive programs to address modifiable risk factors (health behaviors) for stroke (i.e., smoking cessation, physical activity, healthy dietary habits and weight reduction) and, if needed, to help prevent unhealthy alcohol consumption [2][3][4].…”